Provider Demographics
NPI:1649333444
Name:JOHNSON, DEBORAH SUZANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SUZANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3074
Mailing Address - Street 2:
Mailing Address - City:NICE
Mailing Address - State:CA
Mailing Address - Zip Code:95464-3074
Mailing Address - Country:US
Mailing Address - Phone:707-994-7090
Mailing Address - Fax:707-994-7096
Practice Address - Street 1:6300 E HWY. 20
Practice Address - Street 2:
Practice Address - City:LUCERNE
Practice Address - State:CA
Practice Address - Zip Code:95458
Practice Address - Country:US
Practice Address - Phone:707-274-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical